Changes in Perfusion CT of Advanced Squamous Cell Carcinoma of the Head and Neck Treated during the Course of Concomitant Chemoradiotherapy

K. Šurlan-Popovič; S. Bisdas; Z. Rumboldt; T.S. Koh; P. Strojan

doi:10.3174/ajnr.A1859

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Fig 1.
BF maps at admission (A) and after the completion of 40 Gy (B) of concomitant cisplatin-based chemoradiotherapy in a responder with squamous cell carcinoma of the oropharynx (arrows). Note the significant reduction of the tumor volume at 40 Gy, accompanied by lower BF values. Serial BV imaging at the baseline (C) and after 40 Gy (D) of concomitant chemoradiation in a nonresponder with squamous cell carcinoma of the hypopharynx. The BV maps demonstrate clearly the increase of BV in the tumor site during the follow-up (arrowheads).

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Table 1:

Demographic and clinical data

Patient	Sex/Age, Years	TNM	Tumor Site
1	M/74	T3N2b	Oropharynx
2	M/52	T3N2c	Oropharynx
3	M/49	T4N2b	Oral cavity
4	M/69	T2N2c	Hypopharynx
5	M/47	T4N2c	Oropharynx and oral cavity
6	M/59	T4N2c	Oral cavity
7	M/52	T3N2b	Oropharynx
8	M/66	T4N2a	Oropharynx
9	M/65	T3N0	Hypopharynx
10	M/56	T4N0	Hypopharynx
11	M/59	T4N3	Oropharynx
12	F/70	T4N1	Oropharynx and oral cavity
13	M/60	T4N2c	Oropharynx and hypopharynx
14	M/64	T4N2	Hypopharynx
15	M/62	T3N0	Hypopharynx
16	M/40	T3N1	Oropharynx
17	M/64	T2N2b	Oropharynx
18	M/70	T4N2c	Hypopharynx
19	M/63	T4N2b	Hypopharynx
20	M/54	T4N2c	Oral cavity

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Table 2:

Perfusion parameters (mean ± SD) in the pooled patients as well as separately in responders and nonresponders at 0, 40, and 70 Gy of concomitant chemoradiotherapy.

	0 Gy			40 Gy			70 Gy
	Pooled Patients	Responders	Nonresponders	Pooled Patients	Responders	Nonresponders	Pooled Patients	Responders	Nonresponders
BF (mL/min/100 g)	70.4 ± 7.9	72.6 ± 9.1	69.7 ± 7.4	76.2 ± 19.1	67.5 ± 5.9	87.7 ± 23.1	66.1 ± 28.1	53.0 ± 15.1	87.8 ± 30.1
BV (mL/100 mL)	6.1 ± 1.9	6.4 ± 1.4	7.3 ± 2.8	6.9 ± 2.2	5.1 ± 1.0	8.5 ± 3.2	6.5 ± 2.9	5.0 ± 1.4	8.3 ± 2.4
MTT (s)	8.2 ± 3.9	7.6 ± 3.2	9.3 ± 4.1	7.8 ± 2.7	6.9 ± 2.4	9.1 ± 4.0	9.9 ± 2.7	9.6 ± 2.7	10.1 ± 4.2
Permeability (mL/min/100 g)	14.0 ± 4.8	14.1 ± 3.3	13.1 ± 5.6	16.7 ± 8.2	13.6 ± 5.0	20.7 ± 9.1	18.2 ± 11.9	15.9 ± 7.9	21.3 ± 6.1

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Table 3:

ROC curve analysis of PCT parameters for early response (tumor volume shrinkage ≥30%) to concomitant chemoradiotherapy

Value	Criterion	AUC	P	Sensitivity, %	Specificity, %	Positive LR	Negative LR
Baseline BF	>70.4	0.54	.4	57.3	80.0	3.0	0.6
BF (40 Gy)	≤*74.4*	*0.82*	*.03*	*90.0*	*80.0*	*4.4*	*0.2*
Baseline BV	≥*5.0*	*0.83*	*.01*	*59.5*	*100*		*0.4*
BV (40 Gy)	≤*6.9*	*0.80*	*.02*	90	80	*5.2*	*0.0*
Baseline MTT	≤9.0	0.60	.8	71.4	60	1.8	0.5
MTT (40 Gy)	≤*9.2*	*0.83*	*.04*	*100*	60	*2.4*	*0.0*
Baseline PS	>10.0	0.63	.1	100	60	2.2	0.0
PS (40 Gy)	≤12.6	0.80	.06	65	100		0.4

Note:—The values of the provided criteria are the cutoff thresholds for predicting the defined early response. The statistically significant values (P ≤.05) are set in boldface italics; the values approaching statistical significance (P = .06) are set in lightface italics. Values for BF are in mL/min/100 g; for BV, mL/100 mL; for MTT, seconds; and for PS, mL/min/100 g.